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The Prevalence and Features of the Polycystic Ovary Syndrome in an Unselected Population

Departments of Obstetrics and Gynecology (R.A., K.S.W., R.R., E.S.K.), Medicine (R.A.), and Occupational Health and Safety (T.J.K.), The University of Alabama at Birmingham, Birmingham, Alabama 35233; and Department of Internal Medicine (B.O.Y.), Endocrinology and Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey, 06100

Address all correspondence and requests for reprints to: Ricardo Azziz, M.D., M.P.H., M.B.A., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160 W, Los Angeles, California 90048. E-mail: azzizr{at}cshs.org.

Notwithstanding the potential public health impact of the polycystic ovary syndrome (PCOS), estimates regarding its prevalence are limited and unclear. Between July 1998 and October 1999, 400 unselected consecutive premenopausal women (18–45 yr of age) seeking a preemployment physical at the University of Alabama at Birmingham were studied (223 Black, 166 White, and 11 of other races). Evaluation included a history and physical examination, a modified Ferriman-Gallwey hirsutism score, and serum screening for hyperandrogenemia, hyperprolactinemia, and 21-hydroxylase-deficient nonclassical adrenal hyperplasia. PCOS was diagnosed by the presence of the following: 1) oligoovulation, 2) hyperandrogenemia and/or hirsutism (modified Ferriman-Gallwey score 6), and 3) the exclusion of related disorders. Confirmed PCOS was established in those individuals whose evaluation was complete and indicative of PCOS, and possible PCOS was established when the hormonal evaluation was not complete or was unavailable, but the clinical phenotype was otherwise suggestive of the disorder. The individual probability of PCOS in women with possible PCOS was assigned a weight based on the findings in similar subjects whose evaluation was complete, and the total number of PCOS cases arising from these individuals was calculated (i.e. individual probability of PCOS x total number of subjects in the group). The cumulative prevalence of PCOS in our population was 6.6% (26.5 of 400), including 15 subjects among the 347 women completing their evaluation and a calculated prevalence of 11.5 subjects among the remainder. The prevalence rates of PCOS for Black and White women were 8.0 and 4.8%, respectively, not significantly different. These data from a large representative unselected population support the concept that PCOS is the most common endocrine abnormality of reproductive-aged women in the United States.

This work was supported in part by Grants RO1-HD29364 and K24-D01346 from the National Institutes of Health (to R.A.) and by an American College of Obstetricians and Gynecologists/Parke-Davis award (to E.S.K.).

Abbreviations: A4, Androstenedione; BMI, body mass index; DHEAS, dehydroepiandrosterone sulfate; 21-OH, 21-hydroxylase; 17-HP, 17-hydroxyprogesterone; mF-G, modified Ferriman-Gallwey; NCAH, nonclassical adrenal hyperplasia; PCOS, polycystic ovary syndrome; T, testosterone.

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				M. O. Goodarzi, N. A. Shah, H. J. Antoine, M. Pall, X. Guo, and R. Azziz Variants in the 5{alpha}-Reductase Type 1 and Type 2 Genes Are Associated with Polycystic Ovary Syndrome and the Severity of Hirsutism in Affected Women J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 4085 - 4091. [Abstract] [Full Text] [PDF]

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				X. Chen, D. Yang, L. Li, S. Feng, and L. Wang Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome Hum. Reprod., August 1, 2006; 21(8): 2027 - 2032. [Abstract] [Full Text] [PDF]

				M. Mohlig, A. Jurgens, J. Spranger, K. Hoffmann, M. O Weickert, H. W Schlosser, T. Schill, G. Brabant, A. Schuring, A. F H Pfeiffer, et al. The androgen receptor CAG repeat modifies the impact of testosterone on insulin resistance in women with polycystic ovary syndrome. Eur. J. Endocrinol., July 1, 2006; 155(1): 127 - 130. [Abstract] [Full Text] [PDF]

				M. J. Himelein and S. S. Thatcher Depression and Body Image among Women with Polycystic Ovary Syndrome J Health Psychol, July 1, 2006; 11(4): 613 - 625. [Abstract] [PDF]

				S.K. Blank, C.R. McCartney, and J.C. Marshall The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome Hum. Reprod. Update, July 1, 2006; 12(4): 351 - 361. [Abstract] [Full Text] [PDF]

				J. M. Vink, S. Sadrzadeh, C. B. Lambalk, and D. I. Boomsma Heritability of Polycystic Ovary Syndrome in a Dutch Twin-Family Study J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2100 - 2104. [Abstract] [Full Text] [PDF]

				E. Codner, N. Soto, P. Lopez, L. Trejo, A. Avila, F. C. Eyzaguirre, G. Iniguez, and F. Cassorla Diagnostic Criteria for Polycystic Ovary Syndrome and Ovarian Morphology in Women with Type 1 Diabetes Mellitus J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2250 - 2256. [Abstract] [Full Text] [PDF]

				K. Rautio, J.S. Tapanainen, A. Ruokonen, and L.C. Morin-Papunen Endocrine and metabolic effects of rosiglitazone in overweight women with PCOS: a randomized placebo-controlled study Hum. Reprod., June 1, 2006; 21(6): 1400 - 1407. [Abstract] [Full Text] [PDF]

				S. Sam, R. S. Legro, P. A. Essah, T. Apridonidze, and A. Dunaif Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome PNAS, May 2, 2006; 103(18): 7030 - 7035. [Abstract] [Full Text] [PDF]

				T. L. Setji, N. D. Holland, L. L. Sanders, K. C. Pereira, A. M. Diehl, and A. J. Brown Nonalcoholic Steatohepatitis and Nonalcoholic Fatty Liver Disease in Young Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1741 - 1747. [Abstract] [Full Text] [PDF]

				N. Xita and A. Tsatsoulis Fetal Programming of Polycystic Ovary Syndrome by Androgen Excess: Evidence from Experimental, Clinical, and Genetic Association Studies J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1660 - 1666. [Abstract] [Full Text] [PDF]

				L. Ibanez and F. de Zegher Low-dose flutamide-metformin therapy for hyperinsulinemic hyperandrogenism in non-obese adolescents and women Hum. Reprod. Update, May 1, 2006; 12(3): 243 - 252. [Abstract] [Full Text] [PDF]

				J. C. Lo, S. L. Feigenbaum, J. Yang, A. R. Pressman, J. V. Selby, and A. S. Go Epidemiology and Adverse Cardiovascular Risk Profile of Diagnosed Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1357 - 1363. [Abstract] [Full Text] [PDF]